The depression management programme included the following elements:

• An evaluation visit with the primary care physician
  
• The provision of an information booklet before the evaluation visit to encourage acceptance of treatment: Katzelnick DJ, Simon GE, Pearson SD, et al. Depression isn�t just a mental problem. Available on request from the authors.
  
• Pharmacotherapy for eligible patients: physicians were given a specific pharmacotherapy algorithm but could adjust treatment according to individual clinical need. Patients who had tolerated and responded to a particular antidepressant were given that antidepressant. All others received sertraline, 50 mg/day to start. The dose was increased at 4 weeks if patients did not improve, with a maximum dose of 200 mg/day. Patients who did not respond to sertraline were given nortriptyline, 25 mg/day to start and titrated to 100 mg/day if needed. If patients still did not respond, then physicians were strongly encouraged to refer patients to psychiatrists.
  
• Referral to psychiatrists for patients with psychotic symptoms, mania, or acute suicidality.
  
• Ongoing monitoring, feedback, and as needed specialty consultation.